Provider Demographics
NPI:1093814394
Name:RADFAR, ARASH (MD)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:RADFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64445
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4445
Mailing Address - Country:US
Mailing Address - Phone:410-328-5767
Mailing Address - Fax:410-328-0098
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 240
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213833207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416495401Medicaid
MD956595-01OtherCAREFIRST MARYLAND
690005454OtherRAILROAD MEDICARE PTAN
MDS045-0036OtherCAREFIRST REGIONAL
MDS045-0036OtherCAREFIRST REGIONAL